Munchausen Syndrome

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Munchausen syndrome facts

Munchausen syndrome is a mental disorder that is characterized by the sufferer causing or pretending to have physical or psychological symptoms in his or herself.

Adults aged 20-40 years are the most likely groups to develop Munchausen syndrome. Women with some knowledge or training in health care and men with little familial attachment are particularly vulnerable to this disorder.

Munchausen syndrome is often either preceded by or coexists with Munchausen syndrome by proxy.

It is estimated that Munchausen syndrome occurs in a small portion of the United States population, with higher tendencies to occur in subpopulations like people who have been diagnosed as having psychosis or fever of unknown origin.

Munchausen syndrome has been described since at least biblical times. It was named for Baron Karl Friedrich von Munchausen, an 18th-century man who joined the Russian military and was known to tell fantastic tales about the battles he participated in.

Munchausen syndrome by proxy (MSBP) is a fabrication of illness by a third person that allows the third person, usually the victim's mother, to assume the caregiver's role.

Although there is no specific cause for Munchausen syndrome, risk factors for the disorder tend to be psychological as in having borderline or antisocial personality traits or a grudge against the medical profession and social, like having a personal or familial history of serious illness or a history of neglect, abuse, or other maltreatment.

Due to the chronic nature of the illness, as well as the tendency of sufferers to flee treatment, the treatment of Munchausen syndrome is difficult. No single approach is consistently effective in managing this illness.

Prevention or early treatment of the factors that place people at risk for developing Munchausen syndrome are important aspects of decreasing the likelihood that the disorder will develop. Once symptoms of the disorder are determined, the earlier it is addressed, the better the likely outcome.

What is Munchausen syndrome?

Munchausen syndrome is a mental disorder that is characterized by the sufferer causing or pretending to have physical or psychological symptoms in his or herself. It is thought to be motivated only by a desire to be seen as ill rather than by avoiding responsibility, financial gain, improving his or her physical condition, or some other benefit, as is true in malingering. Research outcomes differ in terms of identifying groups that are susceptible to developing the disorder. Some statistics indicate that women with health training may be more vulnerable to developing Munchausen syndrome, particularly when it presents with physical symptoms. However, it is thought by other investigators that men and women experience Munchausen syndrome in equal frequency. Still other studies describe middle-aged men who are unmarried and estranged from their families as being the most susceptible to developing this illness. While the disorder may occur at any age, it seems to most often develop in late adolescence or early adulthood and is either preceded by or coexists with Munchausen syndrome by proxy. Munchausen syndrome is also referred to as factitious disorder.

It is estimated that Munchausen syndrome occurs in a small percentage of the United States population. How common it is can be significantly higher in certain subpopulations. For example, some cases of fever of unknown origin are the result of this disorder. Some people who were previously diagnosed as having psychosis were found to have Munchausen syndrome.

Even before it was given its current name, this illness has been described since at least biblical times. For example, sufferers of this attention-seeking syndrome during the Middle Ages have been known to scrape off their skin and put leeches in their own mouths in order to induce bleeding. This disorder was named for Baron Karl Friedrich von Munchausen. Baron von Munchausen lived from 1720 to 1797, was born in Germany, joined the Russian military, and was known to tell fantastic tales about the battles he participated in against the Ottoman Turks. For example, he apparently told stories about riding cannonballs and traveling to the moon.

In contrast to Munchausen syndrome, Munchausen syndrome by proxy (MSBP) is a fabrication of illness by a third person that allows the third person, usually a caretaker, to assume the sick role. The caretaker usually involved in the development of MSBP is the victim's mother. Although both Munchausen syndrome and somatoform disorders can be characterized by physical complaints, Munchausen syndrome is different in that the complaints are consciously invented or caused by the sufferer him or herself. For example, in somatization disorder, conversion disorder, and hypochondria, the individual is convinced that they really suffer from physical symptoms, have a deficit in movement or sensory function, or are seriously ill, respectively.

How Is Munchausen Syndrome Treated?

Although a person with Munchausen syndrome actively seeks treatment for the various disorders he or she invents, the person often is unwilling to admit to and seek treatment for the syndrome itself. This makes treating people with Munchausen syndrome very challenging, and the outlook for recovery poor.

When treatment is sought, the first goal is to modify the person's behavior and reduce his or her misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that may be causing the person's behavior.

As with other factitious disorders, the primary treatment for Munchausen syndrome is psychotherapy or talk therapy (a type of counseling). Treatment usually focuses on changing the thinking and behavior of the individual (cognitive-behavioral therapy). Family therapy may also be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder.

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Munchausen Syndrome

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